California a bright spot in Obamacare sign-ups

Chad Terhune

Amid slipping support nationally for President Obama's healthcare law and a backlash over canceled policies, California remains a bright spot with nearly 80,000 people signing up for health insurance in the state-run exchange.

Still, California has several major challenges to address if it wants to reach its goal of enrolling up to 1.2 million people in subsidized health plans by the end of next year.

The state's first month of enrollment was dominated by older people — despite extensive marketing to younger, healthier consumers. And very few Latinos have signed up — even though they make up about half of the state's 7 million uninsured and stand to gain significantly from federal premium subsidies.

Covered California, the state's exchange, continues to outshine the troubled federal marketplace and its balky HealthCare.gov website. The enrollment growth comes as a Kaiser Family Foundation poll released Friday shows that roughly half of Americans view the Affordable Care Act negatively — with a steep drop-off in support among Democrats. It was the widest split over the law in that poll since 2011.

"The fact California is performing well provides a strong example that this can work," said Ken Jacobs, chairman of the UC Berkeley Center for Labor Research and Education and an expert on the healthcare law. "I think a lot of the criticism would blow over if the federal exchange could catch up to California."

State officials and other healthcare experts cautioned against reading too much into these early figures, and they predicted trends will change over the six-month enrollment period that ends March 31.

"It's really too early to make a judgment about the situation," said Sara Collins, a vice president at the Commonwealth Fund, a nonprofit healthcare foundation in New York. "It will take a long time for some people to understand their options and make a decision."

In California, a growing number aren't waiting. The state had 30,830 health plan enrollees in October, its first month. And by Nov. 19, it had enrolled nearly 50,000 more people in private health plans for a seven-week total of 79,891.

San Jose couple Rosario and Justine Consiglio, both 57, say they were surprised at how much they saved when they enrolled in a Gold-level plan from Blue Shield of California last week. Their monthly premiums will drop from $1,100 now to $850 next year, helped by a premium subsidy. And they will pay far less out of pocket for prescription drugs and other medical expenses.

"This is a much better healthcare plan than we had previously, and we're paying a lot less," Rosario Consiglio said. "I wasn't sure how all this would affect us."

California said about 2,700 people are signing up for insurance coverage daily. By comparison, fewer than 3,000 Texans picked a health plan through the federal exchange during the whole month of October.

Covered California only gave a breakdown by age for its October enrollment, and people signing up then were older than the state's population overall. To make the healthcare law work, it's important for exchanges to recruit enough young and healthy people to offset the higher costs incurred by older, sicker patients.

For October, 56% of health plan enrollees were 45 to 64, even though that age group represents only a quarter of the state's population.

The coveted group of 18- to 34-year-olds accounted for 23% of October sign-ups, roughly in line with their share of the population. The state said children were under-represented in the insurance figures because many of them qualify for Medi-Cal, the state's Medicaid program for the poor.

Peter Lee, executive director of Covered California, said he wasn't surprised that older consumers rushed in first, considering many have been locked out of the current market because of preexisting medical conditions, or have been paying high premiums for years. The exchange and backers of the healthcare law marketing to young people said they were pleased by the turnout among people in their 20s and 30s.

"Not only are we seeing strong enrollment numbers overall, but enrollment in key demographics like the so-called young invincibles is very encouraging," Lee said.

Another potential weak spot for the exchange was that only 3% of October enrollment, or less 1,000 people, were primarily Spanish speakers. Overall, that group is 29% of California's population and a key target for the state's $80-million marketing campaign.

Lee said those numbers should begin to ramp up as more Spanish-speaking enrollment counselors go out to assist consumers in person.

While the Covered California website and call centers have operated fairly smoothly, it has struggled to clear a backlog of enrollment counselors and insurance agents who have been waiting to get trained and certified.

"The ground game and outreach in a culturally competent way will be very important for success with Latinos," Jacobs said.

In addition to nearly 80,000 people who have picked a health plan in California, 135,000 have applied and appear likely to qualify for Medi-Cal, according to the state.

As for insurance companies, people signing up in the first month went primarily with the biggest names in the state.

Anthem Blue Cross, a unit of insurance giant WellPoint Inc., led the way with 8,658 enrollees in October, for a 28% market share.

Kaiser Permanente, the state's largest nonprofit health insurer, was a close second with 8,250 people, or 27%. Blue Shield of California had 7,903 enrollees, or 26%, while Health Net Inc. trailed with 4,839 people, or 16%.

The seven other insurers in the exchange, many of them smaller health plans available only in certain areas, had 1,180 enrollees combined.

Health Net, based in Woodland Hills, has attracted considerable attention with some of the lowest rates across much of Southern California. In contrast, Kaiser has some of the highest premiums statewide.

Analysts say it's premature to draw any firm conclusions, but early returns show low price may not be everything to insurance shoppers.

"I think we're seeing the importance of brand here," said Micah Weinberg, a senior policy advisor at the Bay Area Council, an employer-backed nonprofit group. "Consumers are not just shopping on price but also going with what they know."

Californians won't be able to sign up online at http://www.coveredca.com from late Friday to early Monday as the state retools its enrollment website for individuals and small employers.